What is a Micro-fracture?
A micro-fracture is when tiny holes are made surgically into a damaged area of cartilage in the knee to stimulate healing. Cartilage is a smooth protective layer which allows the bones to glide over one another easily. The holes which are made cause bone marrow to come to the surface and form a clot over the area being treated. The bone marrow contains cells which make new cartilage to cover damaged area. The new cartilage is not as strong as your natural cartilage bit it gives a coating to the area which was previously bare.
A micro-fracture is performed during an arthroscopy. An arthroscopy is an operation that enables an orthopaedic surgeon to examine the inside of a joint by making very small incisions around the knee and inserting a narrow telescope. When the area to be treated has been identified, the surgeon can use the same incisions to perform the microfracture.
Whate are the benefits of having a micro-fracture?
The benefits of this operation are to:
- Reduce pain
- Improve mobility
- Help prevent the need for further surgery
Immediately after theatre
You can start your exercises as soon as you remember to when you return from theatre, you will find them in this booklet. Your knee will be wrapped in a thick bandage but you should try to start moving your knee as much as the bandage allows. Staff will help you to get up with the crutches when you have recovered sufficiently from the anaesthetic.
Before you are discharged you will be given specific advice about your wound care and pain relief. The leaflet contains general information about this.
The small wounds from the arthroscopy will usually be closed with a single stitch and a paper strip. These are covered with a see-through dressing and your knee is then wrapped in a layer of cotton wool and a crepe bandage.
48 hours after the surgery you should remove the crepe bandage and cotton wool layer. Do not disturb the see through dressings and make sure that you keep them clean and dry. You will need to make an appointment with your practice nurse 7-10 days after your operation for your wound to be reviewed and stitches removed. If at any time you notice any discharge, smell, irritation, or redness around the wounds/dressings, you must contact your GP.
Managing your pain
It is likely that your pain will be well controlled immediately post operatively as local anaesthetic is usually placed into the joint during the procedure. It is therefore sensible to take some regular pain relief so that when the local anaesthetic wears off you remain comfortable. Although the knee arthroscopy often helps with the symptoms you have been experiencing your knee will react to the surgery and this can sometimes take a little while to settle down.
Should you experience any increase in pain and swelling not relieved by elevation and rest, or any pain in the calf, please consult your GP.
Swelling of the knee is part of the natural healing process but if it becomes excessive this can lead to increased pain, increased time for wound healing, general discomfort and slower return to activities.
Swelling naturally peaks at 3-5 days following an injury or surgery.
It is strongly affected by gravity and so if you spend a lot of time on your feet then it is likely to increase as a result. Gravity can be used in our favour by elevating the affected limb. We therefore suggest that you pace your activity, especially over the first week after surgery. Try to keep your leg up whenever you sit and try to rest your leg in a position where your knee is higher than your hip for short periods through the day.
Ice can be a very useful tool to help with both swelling and pain. You should be cautious with its use to ensure that you do not damage your skin. We suggest that you follow the precautions below:
- You should ensure that the area to be treated is sensitive to temperature by placing a cold and then a warm object against it and making sure you can tell the difference.
- Use crushed ice, gel packs or even frozen peas as an icepack but always ensure that there are 2 layers of towel between your skin and the ice pack.
- Check the skin beneath the ice pack after 10 minutes, the skin is likely to be red but should not be white or blue. If you are concerned then the ice pack should be removed immediately. If your skin is frail or has poor circulation then you should check it after 5 minutes. If there is no adverse reaction then the pack can be reapplied for a total of 20 minutes
- Ice packs are most effective when applied for 10-20 minutes every 3-4hours.
IF YOU FEEL PAIN AT ANY STAGE ALWAYS REMOVE THE ICEPACK AND CHECK THE SKIN FOR SIGNS OF LOSS OF CIRCULATION E.G. WHITE/PURPLE /BLUE OR VERY COLD SKIN. ICE PACKS USED INCORRECTLY CAN CAUSE ICE BURNS.
For the first 6 weeks following your surgery you will not be able to put any weight on your operated leg. You will be issued with, and taught to use a frame, and then crutches by a member of the physiotherapy team.
Post-operative follow – up
You will need an outpatient physiotherapy appointment after your surgery. We will usually contact you at home to arrange this appointment within a few days of discharge.
The surgeon will decide after the operation when he wants to see you again. This is usually between 6-12 weeks after the operation or he may not require to see you again and put you on an open appointment. This will be explained when you are discharged.
It is important to start exercising soon after your surgery to ensure that you regain normal movement and strength. The strength of the thigh muscle (the quadriceps) is vital to knee stability and reducing the risk of further injury.
It is important to perform this first exercise 500 times, 3 times a day. This may seem like a lot but the reason is as follows. During the micro-fracture procedure the holes are drilled into the damaged cartilage to allow bone marrow to come to the surface and form clots. The bone marrow contains cells which make new cartilage. This bone marrow then needs to be spread to cover the surface of the bone. This is achieved by bending and straightening the knee, which is why so many repetitions of this exercise is needed.
- Sit or lie with your legs out straight. Gently and slowly slide your heel towards your bottom until it feels tight, then slowly straighten your leg. Do this as pain allows. As your knee bend gets easier you can practice bending your knee while sitting in a chair. Repeat 500 times 3x a day.
It is important to perform the following exercises 4-6 times per day. We suggest that you exercise little and often throughout the day. Slow controlled exercises are more effective and more comfortable than quick movements. You may experience some discomfort initially with these exercises but it is important not to push into pain. If your pain persists please contact your GP or physiotherapist.
2. In sitting or lying with your leg supported, tighten thigh muscles and straighten the knee as far as you can. Repeat 10 times.
3. Place a rolled up towel under your knee. Lift your foot and lower leg up to exercise the thigh muscle. Repeat 10 times.
4. As exercise 2 but now, keeping your knee straight, left your leg. Hold for a few seconds then slowly lower. Repeat 10 times.
Returning to normal activities:
You will be unable to drive for at least 6 weeks during your non-weight bearing period because you cannot put any weight or pressure on your operated leg. You can drive when you feel safe to perform an emergency stop. It is advisable to inform your insurance company that you have had a knee arthroscopy. If in doubt, liaise with your consultant, physiotherapist or GP.
Your return to work will depend on your job. Please discuss this with your doctor or physiotherapist.
Your return to sport will depend on the type of activity and the level you play at. Please discuss with your Physiotherapist what sports you can do and when.
We advise you to refrain from flying for at least 6 weeks after surgery.
If you have a query about exercises or movements, or have not seen a Physiotherapist before being discharged home please contact: Yeovil District Hospital Therapy Department on 01935 384358